Delayed Healing in Fibula Fractures: Key Questions Answered

Right leg fracture?

Hello Doctor, I am currently working in Vietnam and unable to return to Taiwan due to the pandemic.
I have some questions I would like to ask you regarding my condition, which is summarized as follows:
On September 15, I sustained an injury to the outer side of my right leg near the ankle due to a collision, and the X-ray showed no abnormalities.
I experienced mild pain while walking.
On September 30, the pain worsened, and I sought medical attention locally.
The doctor suspected an infection at the injury site and prescribed antibiotics for three weeks.

On October 28, I still felt pain while walking and visited the doctor again.
An X-ray taken that day revealed a fibula fracture, and I was fitted with a long leg cast, which is expected to be removed in 4-6 weeks.
The X-ray images can be found here: http://ppt.cc/fNH4hx.

On December 24, an X-ray was taken again, and the fracture had not healed, so the cast could not be removed.
The doctor prescribed a calcium supplement (Calcitriol 0.25 mcg, twice a day, one capsule each time) and a healing medication (Lignum dracaenae cambodianae 280 mg, three times a day, four capsules each time).
The X-ray images can be found here: http://ppt.cc/fZQ2Dx, and the medication packaging is shown here: http://ppt.cc/f4lhDx.
I have the following questions for you:
1.
Based on the X-rays from October 28 and December 24, is there no improvement at all, or is the healing process slow?
2.
Given that the fracture was already over a month old before the cast was applied, could this lead to nonunion of the bone?
3.
How long should the cast be kept on in this situation? What duration would be considered abnormal?
4.
Should I continue to wait for healing, or should other interventions be considered? Is there a possibility that I may not be able to walk normally again?
5.
Should I take the calcium supplement and healing medication prescribed by the local doctor?
Thank you very much!

Angelina, 30~39 year old female. Ask Date: 2021/12/28

Dr. Shi Guozheng reply Orthopedics

1.
Slow recovery.

2.
It will still heal.

3.
The cast will be in place for about three months.

4.
Just wait for it to heal.

5.
No medication is needed.

Reply Date: 2021/12/28

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your fibula fracture and the delayed healing process. I understand that you are currently in Vietnam and facing challenges with your treatment. Let’s address your questions one by one.

1. X-ray Comparison (10/28 and 12/24): Based on the information provided, if the X-ray taken on 12/24 shows no signs of healing compared to the one on 10/28, it suggests that the fracture is not healing as expected. In a typical healing process, you would expect to see callus formation and alignment of the bone ends within 6-8 weeks for a fibula fracture. If there is no visible improvement, it indicates a slow healing process or non-union.

2. Impact of Delayed Casting: If the fracture was present for over a month before being immobilized with a cast, it could potentially contribute to delayed healing. Early immobilization is crucial in fracture management to promote proper healing. Delaying the application of a cast can lead to increased movement at the fracture site, which may hinder the healing process.

3. Duration of Casting: Generally, a cast is kept on for 6-8 weeks, but in cases of delayed healing, it may need to be extended. If there is no sign of healing after 8 weeks, your doctor may consider additional imaging or interventions. Prolonged casting beyond 12 weeks without healing may warrant further evaluation, including potential surgical options.

4. Next Steps: If you are still experiencing pain and there is no sign of healing, it is essential to follow up with your healthcare provider. They may consider additional imaging (like an MRI) to assess the fracture site more thoroughly. In some cases, if the bone does not heal properly, surgical intervention may be necessary to stabilize the fracture and promote healing. While it is possible to have long-term effects on mobility if the fracture does not heal, many patients can regain normal function with appropriate treatment.

5. Calcium Supplement and Healing Medication: Taking calcium supplements and any prescribed medications is generally advisable, as they can support bone health and healing. Calcitriol helps in calcium absorption, which is crucial for bone healing. The herbal supplement (Lignum dracaenae cambodianae) may also have properties that support bone healing, but it’s essential to discuss any herbal medications with your doctor to ensure they are safe and appropriate for your situation.

In conclusion, it is crucial to maintain open communication with your healthcare provider regarding your symptoms and treatment progress. If you feel that your current treatment is inadequate, consider seeking a second opinion or discussing the possibility of returning to Taiwan for further evaluation and management. Your health and recovery are paramount, and ensuring you receive the best possible care is essential.

Please take care, and I wish you a smooth recovery.

Best regards.

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